Effects of propofol or isoflurane anesthesia on cellular immunity in patients undergoing iobectomy for lung cancer

Objective To investigate the effects of propofol or isoflurane anesthesia on immune response of the patients undergoing lobectomy for squamous cell or adeno-carcinoma of the lung in terms of T lymphocytes and cytokines.Methods Thirty ASAⅠorⅡpatients of both sexes aged 42-70 yrs undergoing lobectomy for squamous cell or adeno-carcinoma of the lung were randomly divided into 2 groups (n=15 each):groupⅠpropofol and groupⅡisoflurane.Anesthesia was induced with fentanyl 2μg·kg~(-1),midazolam 0.05 mg·kg~(-1),propofol 2 mg·kg~(-1)(groupⅠ)/etomidate 0.3 mg·kg~(-1)(groupⅡ) and vecuronium 0.1 mg·kg~(-1) and maintained with propofol 5- 12 mg·kg~(-1)·h~(-1) groupⅠ/isoflurane 1.3-1.5 MAC (groupⅡ) and intermittent i.v.boluses of fentanyl and vecuronium.The patients were intubated with double-lumen tube and mechanically ventilated (V_T= 8-12 ml·kg~(-1),RR=12 bpm,I:E=1:2).P_(ET)CO_2 was maintained at 30-40 mm Hg.Blood volume was maintained during operation with 6% medium-molecular hydroxyethyl starch (HES) and lactated Ringer's solution.ECG,HR,BP, SpO_2,and P_(ET)CO_2 were continuously monitored during operation.Venous blood samples were obtained immediately before induction of anesthesia (T_0,baseline),10 min after induction of anesthesia (T_1),1 h after skin incision (T_2),immediately after termination of anesthesia (T_3),1h (T_4) and 24 h (T_5) after the end of operation for determination of the expression of CD28~+ on CD4~+ and CD8~+ subpopulations of T cells (flow cytometry),serum concentrations of IL-12,IFN-γ,IL-4 (ELISA) and cortisol (radio-immunoassay).Results The expression of CD28~+ on CD4~+ and CD~+ 8 T cells after operation (at T_4,T_5) was significantly increased as compared to the baseline value (at T_0) in propofol group and was significantly higher than in isoflurane group.Serum IL-12 and IFN-γconcentrations were significantly increased after operation as compared with baseline values in propofol group.Serum cortisol concentration was significantly increased from T_(1-5) in both groups and was significantly higher in isoflurane group than in propofol group.Conclusion Propofol anesthesia enhances activation of T lymphocytes during perioperative period in patients undergoing lobectomy for lung cancer thus promotes immune function against malignant tumor.